# Risk Factors for Clinically Aggressive Melanoma in Veterans

> **NIH VA IK2** · VA BOSTON HEALTH CARE SYSTEM · 2024 · —

## Abstract

Malignant melanoma is one of the top five cancers in Veterans. If diagnosed early, like the
majority of melanomas in the U.S., it is highly curable with local surgery alone in the outpatient
setting. In contrast, clinically aggressive melanoma, defined in this proposal as tumor stage
pT1b, requires sentinel lymph node biopsy under general anesthesia and has a worse
prognosis, accounting for a double the number of melanoma deaths compared to early-stage
disease. There are no melanoma screening guidelines, and thus, there is a critical need for
personalized easy-to-use approaches for melanoma screening to improve health outcomes and
reduce treatment costs. Dr. Rebecca Hartman is a clinical dermatologist and researcher in
epidemiology and health services research who seeks to improve melanoma screening
approaches through personalization of risk assessment in a clinically applicable manner. The
aims of this CDA-2 proposal are to (1) create and validate a clinical risk prediction model for
clinically aggressive melanoma in Veterans and (2) create a genetic risk prediction model for
clinically aggressive melanoma in Veterans and validate a combined genetic and clinical risk
prediction model in an external civilian cohort. Aim 1 will conduct logistic regression analyses to
examine for associations between potential phenotypic risk factors and clinically aggressive
melanoma, including demographics, co-morbidities, disease history, immunosuppression,
military history, environmental exposures, and healthcare utilization. This aim will produce an
easy-to-use clinical risk prediction model for clinically aggressive melanoma that is specific to
Veterans and can be integrated into the electronic health record. Aim 2 will conduct a candidate
gene analysis of previously established cutaneous melanoma SNP risk factors as well as
GWAS to examine for novel genetic risk factors for clinically aggressive melanoma. Cox
proportional hazards regression will be used to create a polygenic risk score for clinically
aggressive melanoma and model performance will be evaluated using decile percentiles of risk
and ROC curve. This aim will produce a polygenic risk score for clinically aggressive melanoma.
Subsequently, the combined clinical and genetic risk prediction model will be validated in an
independent civilian cohort using the Mass General Brigham Biobank. Future directions include
a clinical trial of the clinical risk prediction model, integrated into the electronic health record, to
examine prospective real-world model performance as well as examination of any novel genetic
associations found in GWAS for potential therapeutic applications. This clinical risk prediction
tool will help VA clinicians select patients to triage to dermatology for melanoma screening. The
mentorship, research, and training programs described in this CDA-2 application will propel Dr.
Hartman’s career as an independent VA-based dermato-epidemiologic researcher. Her
mentorship team includes Drs...

## Key facts

- **NIH application ID:** 10485552
- **Project number:** 1IK2CX002531-01
- **Recipient organization:** VA BOSTON HEALTH CARE SYSTEM
- **Principal Investigator:** Rebecca Ivy Hartman
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2023-10-01 → 2028-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10485552

## Citation

> US National Institutes of Health, RePORTER application 10485552, Risk Factors for Clinically Aggressive Melanoma in Veterans (1IK2CX002531-01). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10485552. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*